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SAN�d0A0UIN <br />t` rViii " —COUNTY- <br />9S�rF�nr°" Greatness gro: s here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2 I I2I Inspector: sLk's � 66 CONSTRUCTION <br />Facility Address: <br />Well Address: <br />w6LV'�te:7 b" <br />WP# 0 ui2 � f) <br />Well#: <br />Soil Boring#: <br />Cement 941b <br />Bags <br />Drilling Company: (A-1 <br />1 eP6, So2tS tnC, <br />Driller Onsite: :1 0 <br />ej/ Qkvt_ <br />Consultant: <br />2.5 5 1 <br />Geologist: <br />10 <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑No <br />SAMPLING <br />From: <br />Cement 941b <br />Bags <br />Holding Temperature: <br />#Bags <br />Thickest Thinnest <br />5 <br />Method: <br />#Bags <br />1 <br />2.5 5 1 <br />Screening Method: <br />10 <br />2 <br />Verified Chain of Custody: <br />❑ Yes <br />1:1 No <br />SPOILS <br />15 <br />3 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />20 <br />4 <br />Covered: <br />❑ Yes <br />El No <br />If yes, material: <br />25 <br />5 <br />GROUTING or DESTRUCTION Total Depth: Z i0 <br />Depth to Water: <br />Grout Material: (b,3 Sin',- Ce -n e <br />Gallons of Grout Used: — 13 v&w <br />voTdvf,hvlZat" abortZo/ <br />❑Well Installation I1/ell"Destructlon <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity -Niremie Wither: <br />Water <br />allons <br />From: <br />Cement 471b <br />Ba <br />Water <br />allons <br />From: <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />5 <br />10 <br />#Bags <br />1 <br />2.5 5 1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />n <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: _ <br />Filter Pack Type/Size: <br />Type of Method: <br />ft. <br />Screen Feet <br />Bentonite/Gement Mix <br />Bentonite per 47 Ib <br />3% Mix 5% Mix <br />1.4'1 2.47 <br />Bentonite per 94 Ib <br />2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />